A REVISED digital health literacy scale now shows that navigating online health care requires multiple distinct skills rather than one broad ability, according to a large population survey from Canada.
Why The Digital Health Literacy Scale Needed Rethinking
As health services increasingly move online, digital health literacy has become essential for accessing information, booking services, and making informed decisions. The digital health literacy scale, commonly measured using the eHealth Literacy Scale, has traditionally been treated as a single construct. However, growing evidence suggests that people may be confident in using digital tools while struggling to judge information quality or navigate complex resources. Recognising these differences is critical for designing effective public health interventions and addressing digital inequities.
Validating a Multidimensional Digital Health Literacy Scale
Researchers conducted a secondary analysis of cross-sectional data from the 2022 GetCheckedOnline community survey in British Columbia. The study included 1657 participants with a mean age of 33.0 years (SD 11.77, 95% CI 32.4-33.6). Among respondents, 47.3% (95% CI 44.9%-49.7%) identified as women, 30.4% (95% CI 28.1%-32.6%) as racialized minorities, and 80.5% (95% CI 78.5%-82.3%) reported easy internet access. Digital health literacy was assessed using the eHealth Literacy Scale with a 5-point Likert response format. Median scores across items were 4.0 (IQR 1.0-2.0), with excellent internal consistency shown by a polychoric ordinal alpha of .92. Exploratory factor analysis supported a three-factor structure explaining 65.7% of the variance. Confirmatory analysis demonstrated good model fit with χ²17=71.7, P<.001, root mean square error of approximation 0.059, standardized root mean square residual 0.026, comparative fit index 0.969, and Tucker Lewis Index 0.948. The final digital health literacy scale model comprised Information Navigation, Resource Appraisal, and Confidence in Use, each showing strong standardized loadings and composite reliability between 0.784 and 0.900.
Implications For Clinical Practice and Policy
A multidimensional digital health literacy scale allows clinicians, services, and policymakers to better identify where patients struggle online. Targeted support can then be developed to improve navigation, appraisal, or confidence, ultimately supporting more equitable access to digital health care as technologies continue to evolve.
Reference
Iyamu I et al. Development and validation of a revised multidimensional digital health literacy scale: secondary analysis using cross-sectional data from the 2022 GetCheckedOnline community survey In British Columbia, Canada. J Med Internet Res 2025;27:e78008.
